The Feinstein 1200

Monday, March 22, 2010

Thanks to all who wrote in during the last two weeks that the F1200 newsletter was on leave. During that time, our most active members continued to meet with and plan for an upcoming pre-midterm election "mixerpalooza” that we’re planning with five other local Democratic and progressive groups. Separately, we’ve been developing and pitching the Constitutional Amendment Reality TV show, and organizing our crew for an upcoming educational outreach to conservative groups.

Meanwhile, the Newsletter “bleat” was happy to remain muted for the last two weeks as the President stepped forward ever more assertively to see through his own trademark legislation. At a certain point, it was clear that the legislation would go forward on the leadership of the President and the House, rather than on our deathless phonebanking.

While the legislation is hardly the package we had hoped for, even some of the bill’s most ardent progressive critics believe this could be an important start toward real reform.

But there's another upside: For those of us who came to view the dragged-out HCR process as a lower priority to more pressing economic issues, the last two months signaled Obama’s maturation into his Presidential role. With his stellar academic credentials and considerable presence, Barack Obama has had the misfortune, if you will, of success in his adult life followed by more success in his adult life. But like many first-term Presidents, his initial year in office was a different experience.

In the aftermath of the Coakley defeat last January, our young President has enjoyed the golden opportunity afforded only to those who, if you will, screw up. And as those of us outside the bubble of White House advisers have been urging for the past year, the “cool and diffident” approach wasn’t going to cut it in a crisis.

Thus, his more active role since the Coakley loss was instructive on a variety of levels:

1. It showed his base that he wasn’t so out of touch that he wouldn’t fight;

2. It was a necessary and welcome display of authority;

3. It was a necessary lesson for the President himself – as The Economist Magazine pointed out in the wake of the Coakley defeat, the President himself had not made an effective and consistent argument for reform; he had not campaigned sufficiently in its support; and he appeared unwilling to use the powers of his office. In short, he didn’t appear willing to fulfill the responsibilities of a President in a time of crisis.

So for yesterday’s “start”, let’s raise a glass to Nancy Pelosi, and to the President. And, in a nod to the “wisdom of crowds”, why not toast the voters of Massachusetts, who put a stop to the “business as usual” that had been enforced by the President’s inner circle? (That inner circle should be dismissed for failing to communicate to the President that the message was being lost as the rest of us sweated it out at various town halls all summer and fall.)

I have occasionally signed off with “Keep the faith.” Given the past year, I want to be more specific: “Keep the faith in your collective goals” – but continue to hold your elected representatives’ feet to the fire. Lost in the last-minute drama of yesterday’s vote, and in the circus-like right-wing antics that can only be sustained when strong Democratic leadership is missing, is one simple reality: yesterday’s victory should never have taken this long, been this close, or traveled so far from its initial goal.

“‘Next week I intend to introduce legislation to create a Medical Insurance Rate Authority to prevent egregious premium rate increases, like the one recently announced by Anthem Blue Cross of California, which will raise certain medical insurance premiums by up to 39 percent,’ Mrs. Feinstein said.”

As you know, Senator Feinstein first broached the subject of rate authorities last October. But they were to be state-wide, not federal. This is definitely an improvement, although one might ask why such a nationwide rate authority wasn’t included in the Senate bill. And one of our readers pointed out:

“If I'm not mistaken, Feinstein has talked about introducing this legislation and creating this regulatory entity for some time. It took this rate-raising action to get her to actually commit when she should have already done this work – rates have been going up astronomically for the past few years, known to all. And I have to say, there can really be no satisfaction unless legislation can actually be passed, including a bill to repeal the anti-trust immunity insurers currently enjoy. Sky rocketing rates and the ability to spend a mere 70% on medical expenses in California are bothunconscionable. So what took Feinstein so long to use that word?”

To put a reality check on our previous enthusiasm for Feinstein’s regulatory proposals, let’s review what Eliot Spitzer described as “the Regulatory Charade” just weeks ago during his talk in San Francisco. (The subject was financial sector regulation, but it’s worth considering how an enthusiasm for regulatory fixes absent the political will for enforcement would apply to health insurance reform.)

“What we are doing is what I call the Regulatory Charade. What do I mean by that? After a crisis of this sort – and it doesn’t matter whether it’s the Enron crisis which generated Sarbanes-Oxley or other crises – there is always the rush to pass a law. Why do we want to pass a law? The virtue of passing a new law is that malefactors in the private sector get to say: ‘Go pay attention to passing a new law, but don’t worry about prosecuting us.’ And the regulators who should have done something can stand up and say: ‘We would have stopped it but we didn’t have the power, so pass a new law to give us the power, and then it won’t happen next time.’

“This is all a charade because the reality is the regulators had the power, they just refused to enforce it. And the people who did the bad things should have been prosecuted. What we should have been doing is actually using the power that we had.

“Think of it this way, over the past year the Fed, the OCC, and the SEC have been doing an amazing number of things.” (Editor’s Note: Spitzer emphasized throughout his presentation that these organizations are still far from doing enough with their current power.) “They haven’t been granted new power to do it. They’ve been using the power they’ve always had, but never called upon. Why didn’t they call upon it before?

“I’ll give you an example from personal experience. We tried to investigate sub-prime lending back when I was AG. We went and served subpoenas and wanted to gather the data. I’d written an article in The New Republic in 2004 saying: ‘This debt’s not going to be repaid, this is bad stuff.’

“The OCC and the banks went to court to stop us from serving the subpoenas and getting the information. They said ‘You’re pre-empting.’ We had to litigate all the way to the U.S. Supreme Court in order to get the power to actually ask the questions to get the information. But worst of all, it’s not as though the OCC and the other federal agencies said: ‘You stop. We are doing it.’ They just said: ‘You stop.’ Nobody was doing it. So the agencies who had the power simply didn’t use it, and this catastrophe simply grew and grew and grew.

“It’s the Peter Principle on steroids. We all know the Peter Principle, where people are promoted to their level of incompetence and they end there. What’s happened in DC is that people are promoted to their level of incompetence. And now, this will seem harsh, and I don’t want to say anything bad about people, but I will. Because of that incompetence, a huge crisis erupts, and they then use the crisis to argue that they should get even more power. And if you look at who is now in charge, it is basically the people who were in charge of the Fed and the Treasury and the OCC and the OTS throughout the time when this crisis was brewing.”

Shorter Eliot: Feinstein’s proposal for proposing legislation (which is all it is now) will mean nothing without the political will to enforce that legislation. Where will that political will come from, if not from industry (for obvious reasons) and not from our elected “representatives”? Pathetic as it sounds, it has to come from us. I predict that we will see, over the next few years, an increasing level of productive and sound engagement on political issues, especially from highly skilled, recent college grads unable to find employment in a languishing economy.

And having offered that important caution from Eliot Spitzer, I will add that many of us (myself included) are optimistic about the upcoming health care reform summit now scheduled for this Thursday. If nothing else, it provides an opportunity to show the American people how much more the Democrats have to offer than the GOP.

We’ll be catching up with Maggie Mahar (and Liz Warren) later this week.

Theron had emailed me about Saturday's opening, but I hadn’t realized that living civil rights legend Clarence Jones will be at the opening. (The opening is for a photo exhibit of images of the civil rights movement. It starts at 7 p.m. at 458 Geary, cross-street Taylor.)

“I don’t see how someone as radical as you ever got to be one of Warren Buffett’s favorite financial journalists,” I said last night to Maggie Mahar, after another screening of the film based on her book, “Money-Driven Medicine.”

Mahar didn’t miss a beat. “Because I write about what’s wrong with capitalism. And what’s wrong with capitalism is how Warren Buffett makes his money.”

I did a double-take, and she quickly explained: “He does that by buying companies that are well-managed.”

Got it. She had only meant to reference Buffett's understanding that market inefficiences can sometimes undervalue potentially strong companies. But for a second there it was a real zinger.

All the same, don’t let Mahar’s Ivy League background and her work for Barron’s fool you – this woman will, without warning, channel Upton Sinclair in her championing of the poorest members of society – with details so stark that “The Jungle” will read like “Pat the Bunny.” We’ll have more detail on her appearance in Sunday’s newsletter. (I want to give the two other F1200’ers who went to see Mahar on Friday night, including a nurse and an M.P.H., more time to gather their thoughts on the event.)

For now I’ll just say that, like Andrew Bacevich with his iconoclastic take on the relationship between personal consumption and US foreign policy, Maggie Mahar challenges us to see the larger picture. “A lack of access to health care is actually very low in terms of causes of premature deaths in the overall U.S. population. It accounts for only 10%.” The greater percentage of premature deaths, Mahar says, is due to behavioral coping mechanisms (the largest of which is self-medication) employed by those forced into poverty. Another 15% is credited to environment, which is also linked to poverty.

We’d raced over at the last minute when we heard Mahar was speaking because we needed to hear this extraordinary journalist’s take on the progress of HCR legislation, and that too will be included in Sunday’s newsletter.

3. Why Can’t Everyone Be Like Larry?

F1200’er Larry has allowed me to share his outstanding letter to Democratic leadership. You can read it here. I honestly believe that we cannot just keep giving money to groups that advocate for our causes and expect results. If democracy can be saved, it will be up to people like Larry and like so many people in the F1200 who take a passionate interest in the process and become involved. And from reading email from younger F1200’ers who have recently graduated from college or just finished their Ph.D.s, I honestly believe that the current employment landscape may prove fertile soil for reform - with the younger generation coming up with new solutions and approaches.

4. Regulation, Schmegulation:

The question of the week for our docs, nurses, and health care policy wonks was whether the regulation proposed by Senator Dianne Feinstein last October would have prevented the 39% Anthem rate hike. But predictably, the proposed language was so vague that no one could agree! One of our nurses contacted Jackie Speier’s office with the question, and is standing by for a callback. She was dismayed that none of the aides in Speier's office knew - because Speier has an outstanding and smart staff.

In the meantime, Maggie Mahar and Eliot Spitzer have each recently answered the question in their San Francisco appearances by reinforcing the message that no amount of regulation will prevent abuses without aggressive enforcement. I hate to tell you this, but since the industry will never ask for such enforcement, you’re going to have to go and find your pitchfork.

Editor's Note: Normally, I would not include such long letters, but I was so moved by this excellent letter from one of the F12oo that I had to include it.

I was particularly impressed that someone took such care and so much time trying to communicate with the leadership they have supported - especially at a time when so many others have simply given up.

President Barack Obama

Senator Harry Reid

Speaker Pelosi

Subject: Health Insurance Reform

Dear President Obama, Senate Majority Leader Reid and Speaker Pelosi:

I am writing to let all of you know how disappointed and dismayed I am about your approach to Health Insurance Reform since the January 19, 2010 Massachusetts Senatorial election. During the last two weeks, your approach to continuing the fight to reform health insurance has been tepid at best. I think that this is exactly the wrong approach at this time! Health insurance reform is too important for the good of the country to let an opportunity one hundred years in the making slip away. I respectfully urge you to seriously reconsider your current approach to health insurance reform.

Usually, politicians give pep talks to the people to get them educated and “fired up” about particular issues. At this particular point in time, I believe that it is you (the politicians) that need the pep talk from the voters on how to proceed on health insurance reform. This letter is intended to be that pep talk. Please understand that I don’t intend this letter to be disrespectful (I support your positions on most of the major issues facing the country today), but I believe that direct and blunt words are now required on this subject.

It is time to seize the initiative on health insurance reform instead of ceding it to the Republicans by default! It is time to stop cowering in the corner and do something before it’s too late!!!

Following are eight points of emphasis supporting these two summary statements. They include my personal assessment of the current situation and some recommendations for your consideration.

While I absolutely don’t agree with their health insurance positions, the Republicans have had better talking points and a better narrative on their health insurance positions over the past year than the Democrats. Yes, they have used gross misrepresentations and fear, but unfortunately it has been effective. You need to develop a strategy and narrative to seize the health insurance reform agenda from the Republicans. In addition, since not one Republican in the House or Senate voted for health insurance reform, there is no longer any need to pander for their support. They have made it clear that their principal goal is the failure of the Obama Presidency, and the best way to achieve that goal is for health insurance reform to fail. This needs to be a key part of your revised narrative and talking points.

2) Develop a better narrative on Health Insurance Reform and Use It Effectively:

You need to focus on developing a better, more compelling narrative and better talking points that effectively counter the Republican misrepresentations and appeals to fear. If you don’t, Democrats will continue to lose ground in the court of public opinion on health insurance reform. Your talking points need to be blunt and hard hitting and they need to point out the inherent selfishness of the Republican’s health insurance positions, the fact that they have not supported any meaningful health insurance reforms, and that their principal goal is the failure of the Obama Presidency. When the Republicans complain about not being included in the House/Senate conference committee, they should be forcefully reminded that not one of them voted for either bill and not one of them has indicated even the slightest willingness to compromise on health insurance issues. Further, you need to continue to emphasize (but more forcefully) that there is agreement on 80 to 90% of the health insurance reform issues, and that the status quo is untenable. Finally, you need to ensure that most, if not all Democrats use these talking points and continue to repeat them often, so that they get sufficient media coverage.

3) Don’t Over Think the Massachusetts Senatorial Election Results:

Yes, the election of Senator Brown was a defeat for the Democrats, but don’t let it paralyze you, and most of all don’t let the Republicans dictate what it means. I think that the election of Senator Brown was caused by a mediocre Democratic candidate, frustration with the slowness of the economic recovery, and Brown’s appeal to voter selfishness on health care (Massachusetts already has health insurance reform in place, so why should they have to support and pay for health insurance reform for the rest of the country?). If the results of this one election cause you to backpedal on your positions on major issues, you will be giving the Republicans exactly what they want, and you will be letting down the people that are responsible for your election.

You have all stated that the country has been trying to reform the health insurance system for more than a hundred years. You also recognize that this is the closest that we’ve ever come to actually achieving it. To get this close and let it slip away would be unforgiveable! Yes, it has been and will continue to be difficult, but this is one of the reasons we elected you: to fight the good fight for those who cannot. We need to get some form of health insurance reform passed after all of this effort. We need to do it for all of the people who don’t have insurance, for all of the people that have been denied coverage because of a pre-existing condition, for all of the people that have had their coverage cancelled because they got sick, and for all of the people that have gone bankrupt because they got sick. If we don’t pass health insurance reform, this issue is going to continue to be serious drag on the economy for years to come.

5) Move quickly and do whatever it takes to pass a Health Insurance Reform Bill:

Time is of the essence and you all know that! The closer we get to the November 2010 Congressional elections, the less likely it is that a health insurance reform bill will pass. Given how long this process has taken already, we no longer have the luxury of taking more time to start over or pursue significant changes to the basic approaches contained in the House and Senate Health Insurance Reform Bills.

What are the options? There appear to be two main options on how to proceed: (1) The House swallows its pride and votes for the Senate Bill, or (2) Use the reconciliation process to (strengthen the bill.) Health insurance reform is too important to let it die once again. It took 17 years after the Clinton Health Care Effort failed to even try again. Can the country afford to wait another 15 to 20 years for Health Insurance Reform? I think not. Should Democrats unite and do what is right for the country instead of worrying about whether they will get re-elected? Absolutely. It is time to be pragmatic, take what we can get (even though it is far from perfect) and move on to the next issue – reforming the banking system. It is better to get 80% of health insurance reform than nothing!

Another possibility to consider is to call the Republican’s bluff on filibustering a combined House/Senate bill before having the House pass the Senate bill as it stands. As I see it, this would involve forcing the Senate Republicans to filibuster the bill for weeks or months and not doing any other Senate business until they stop the filibuster and allow a vote on the Health Insurance Reform Bill. The idea would be to put pressure on the Republicans and to show the country that they are the obstructionists on this issue. Perhaps eventually, one or more of them would change their mind and allow a majority vote on health insurance reform. I realize that this is an unorthodox and potentially risky approach, but desperate times call for desperate measures.

6) The political cost of failure to pass Health Insurance Reform will be far worse than the political cost of passing an imperfect bill:

You may be worried that health insurance reform is now unpopular, and that if you continue to push strongly for it, Democrats will suffer for it in the next election. I believe that this isn’t true. In fact, I think most people would welcome health insurance reform. I believe that the political consequences of failure to pass health insurance reform will be far greater than passing a bill that some people don’t like. In my opinion, if you lay a goose egg on health insurance reform, none of you will be reelected, and the Democrats will likely lose their majority in the House and possibly the Senate in the 2010 elections. You have far more to lose by your inaction on health insurance reform than you do by forcefully fighting for it and doing whatever it takes to get it passed.

7) Show the country and the people who elected you that you can “play hardball” when necessary:

The Republicans are clearly playing hardball on the issue of health insurance reform. They have stated their intention to make the failure of health insurance reform a significant part of their efforts to cause the Obama Presidency to fail. As part of that effort, not one Republican in the House or Senate voted for the respective health insurance reform bills. While your efforts at bipartisanship are admirable, it is clear that the Republicans are not receptive to it on health insurance reform. Thus, there is no need to pursue a bipartisan approach on health insurance reform any further. Bipartisanship requires a willingness to participate and compromise, and it takes two willing parties to make a bipartisan approach work. If the Republicans are unwilling to participate in the process and/or compromise on any issue, despite your best efforts to involve them, it is not your fault. At this point, continued pursuit of a bipartisan approach on health insurance reform is naïve at best.

In short, it is time to play hardball and do whatever it takes (including some serious “arm twisting” by the House and Senate leadership) to get health insurance reform passed, and not worry so much about what the opposition says or thinks. I believe that the majority of Americans support the basics of health insurance reform, but are frustrated by the process of lawmaking. The truth of the “sausage-making simile” comes to mind here. Unfortunately, the process has been long, tortuous and ugly, and people are tired of it. The majority of the people in the country elected you in part to get this done. It is time that all Democrats come together to agree on some form of health insurance reform. Yes, the House and Senate Bills are far from perfect, but they are both far better than the status quo. It is time for everyone to realize that 80% of what you want is much better than nothing. Standing up for principles is fine in most situations. However, there are times when pragmatism wins out. I believe that this is one of those times, because, like the Apollo 13 saga, “failure is not an option.”

8) Make Health Insurance Reform Happen because it’s the right thing to do and it is what the Country wants and needs:

Do this for your own political future, for all those who voted for you, but do it primarily for those who don’t have health insurance and/or access to quality medical care because the current system is unfair and not properly regulated. Do this to honor the memory of Senator Edward Kennedy who fought tirelessly for health insurance reform throughout his career in the Senate. Please ask yourselves: Would he be proud of your current approach?

But most of all, do it because it is the right thing to do and it is what the people of the country want and need. Thank you for all of your hard work that has gotten health insurance reform to this point. Thank you for your consideration of my ideas on these issues. Now let’s get this done for the American People!

Sincerely,

Lawrence __________

(Editor's Note: I am not disclosing the last name of the sender for his privacy.)

Senator Feinstein did not sign this week's letter because 1,200 of us wrote polite letters to her; or put together and attended thoughtful bipartisan policy seminars; or baked cakes for her and her staff; or phone-banked until our fingers went numb. We have done all of those things to no lasting effect.

These are two of the more likely reasons Senator Feinstein signed that letter:

1) The Coakley loss in Massachusetts last month, which made it resoundingly clear that incumbents and Democratic establishment candidates are under attack; and

2) Anthem's recent 39% rate hike, which no doubt generated a large volume of outraged phone calls to her office.

That is understandable. If you want the Senator's respect and cooperation, then remember that she is your public servant and not the other way around. Servants don't respect employers who try to simultaneously give orders and pretend they are also the servant's B.F.F.

So call Senator Feinstein's office staff in San Francisco or in D.C. and be clear about what her job entails. (Separately: It's perfectly appropriate and important to be very polite to her hardworking staff.) Tell the staff that you would like to leave a message for the Senator. Here is the suggested message:

"IfinditveryinterestingthatDianneFeinsteinismakingalate push for the public optionbysigningthisweek'slettertoHarry Reid. I understand that everyone from Teddy Roosevelt to Richard Nixon supported national health insurance. And I know that the majority of Americans, including Californians, want a public option."But I can't thank the senator without results. As a longtime loyal Democrat, I no longer have any patience for Senate Democrats' antics. I note that Senator Feinstein signed the Brown letter for the public option last October, but she provided so little REAL support for it that Nancy Pelosi was calling it dead as recently as two weeks ago.

"There are eleven signatures on this week's letter to Harry Reid; Senator Feinstein should be twisting arms to get all 51 signatures on that letter. She can start with Senator Boxer. "Therefore, this is a 'fair notice' call. Senator Feinstein, as someone with enormous unspent influence in the Senate, can make that signature mean something, or she can face a rebuke from this California Democrat. For the Senator enjoys the mind-boggling perks and privileges of her office only AT MY DISCRETION. I am a voter, and I have not yet had all of my electoral power stripped from me."

It would then be perfectly appropriate to tell the staffer that you appreciate their hard work, and that you wish them a nice day. You can even thank them. But don't thank the Senator for signing a lousy letter; thank her when - and if - she delivers the goods.

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About Me

The Feinstein 1200 comprises the 1,200+ scientists, nurses, physicians, small business owners, artists and engineers who "occupied" Dianne Feinstein's office lobby during the week of August 10, 2009, at the behest of Organizing for America (OFA.)
Since OFA did not send an organizer to perform a headcount, one of us compiled a list of the attendees. We subsequently named ourselves in honor of the Senator whom we had been trying to convince of the importance of the public option and/or single payer.
We have since held a seminar featuring UCSF physicians and UCB economists on the potential savings of the public option. Most of our activity is recorded through a private email newsletter. Less frequently, we place information on this blog.